Provider Demographics
NPI:1043968167
Name:SOTO, STEPHANIE BEATRIZ (RPH)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:BEATRIZ
Last Name:SOTO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BARD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-3208
Mailing Address - Country:US
Mailing Address - Phone:732-900-7181
Mailing Address - Fax:
Practice Address - Street 1:116 BARD AVE APT 3
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-3208
Practice Address - Country:US
Practice Address - Phone:732-900-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist